The whole point of Emergency Care is being available when normality fails.


Here I am writing about this again…Why..? Because people still do not get it and on Facebook today there is yet another article written about why people should go to a primary care provider, in this case a pediatrician, instead of an Emergency Department.

The comment section is full of “Emergency Nurses” carrying on some old line about how many people abuse the emergency department and they are busy and only for sick people, and everyone else is wasting their time…

News flash in simple language so the morons can understand it…

Healthy people do not go to the Emergency Department. What is so hard to understand about that? People go to the emergency department because they have a problem. Hence the term EMERGENCY!

Now like any other emergency service, this problem may not be what you want to deal with or specialize in, but you are still called upon to deal with it. If you don’t like that, I suggest another line of work. In fantasy land, where everyone you see matches your adrenaline junky definition of “emergency.”

If you really want to see sick patients, the ED is not the place. I love to work with the sickest of the sick, and I don’t work in Emergency. You know why? Because after working in Emergency for years, along with rotations in medical school, I discovered something…The really sick patients are in the ICU.

Surgical, Cardiac, Pediatric, whatever flavor you like, if “sick” is what you want, that’s where you find it. Its high stress, high mortality, merciless work, but every patient, and usually family too, are really sick.

The modern Emergency Department is primary care. Why? Because providers are lazy and don’t want to change. They want to practice like they did in the 1880s. 9-5, or in the case of some, 9 O’Clock doctor’s office time, which is anywhere from 40 minutes to 2 hours passed 9 until 1 or 2pm. The only doctors worse at telling time are surgeons. As somebody who does work in surgery, let me give you a brief explanation of Surgery time?

“This will be a fast operation” This will take at least an hour.

“This operation will take an hour” Expect to be finished around 3 hours later.

“This is going to be a long operation” 5 hours at least.

Back on point…

Nobody, in any country, in 2017 wants or needs a primary care provider who cannot see them in a matter of hours. This may interfere with “Lifestyles”, “Quality of work/life balance” etc… Guess what? Nobody cares. If you are not available when people need you, you are worthless. If you do not have the equipment to do your job, you are worthless.

Nobody ever called the Fire Department, reported a fire and received the reply: “ Sorry, we don’t have any hoses at our station, so we will have to refer you to a provider or place that does have a hose who can see you in a week, or 2 weeks, or 2 months…”

Nobody goes to McDonalds tries to order food and hears “Sorry, we don’t see walk-ins, you need an appointment, we’ll be happy to set you up with one in a month…If you can pay up-front.”

Another fact of life…You know which patients keep the doors open and the lights on so you have a job in the ED? The ones who are not “emergent.” These patient’s require less time and resources and since there are vastly more of them, they are the ones paying the bills, padding your census, etc. That doesn’t matter if you are in a single-payer system or a private payer one.

If patients knew and understood medicine, there would be no need for you! The reason you go to school as long as you do, and are recognized by non-experts as the people to ask is because they don’t know, and they know what they don’t know. So they seek help from somebody who does, when they need help.

Responding to their needs in their time of “crisis” is why they put memes on Facebook about how great you are. It is why they thank you for your service, it is why you enjoy not only the pay, but a higher social standing than non-providers and even non-emergent providers.

If you are not an emergency provider, get a clue, your outdated, inconvenient, practice needs to change. You need modern equipment and it is expensive, without it, you are just a useless middleman. You need to be available for patients when they need, not at your convenience. If this means you have to set up a practice with rotating shifts around the clock, or at least 1st and second shift, do it! If not, shut the fuck up…Nobody cares about whatever excuse you have not to.

If you are an emergency provider, nobody cares about your lack of job satisfaction because you are not getting an adrenaline fix with every patient. If you don’t like the reality of what working in the ED or A&E is like, just go. But your incessant public displays of bitching about patients and how they “abuse” the place open 24/7/365 with big red lights on all night, how they don’t know what is an emergency and what is not, and all of your other whiney bullshit, is an embarrassment to all emergency providers.

I have told you where to find sick patients. Your bullshit excuses and arguments about who should be in the ED are now moot. I have told you what you need to do in order for patients to find value in a primary care provider. If you do not do them, your bullshit excuses are moot. If you do not like providing minor primary care, it is you who need to leave the ED, not the patients.

Did I use small enough words for you to understand it this time? Because as long as you keep making posts about “Don’t go to the ED you abuser” I am going to make posts calling you out, and if you are some old ED dinosaur who can’t handle modern Emergency practice as defined by patients, evolve or go extinct, because you are no longer needed.

By the way, I tell everyone, go to the emergency department first. Get only follow-up care from people who can see you in 2 weeks or more after they send you to yet another place for the required diagnostics. Otherwise, you will be better (won’t need their services at all and will have no reason to pay them) or you will be in the ED anyway (because your condition will degrade to an emergency or you’ll be dead).